Primary Neurosurgery for Pediatric Low-Grade Gliomas: A Prospective Multi-Institutional Study From the Children's Oncology Group

Author:

Wisoff Jeffrey H.1,Sanford Robert A.2,Heier Linda A.3,Sposto Richard4,Burger Peter C.5,Yates Allan J.6,Holmes Emiko J.7,Kun Larry E.8

Affiliation:

1. Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York

2. LeBonheur Children's Medical Center (Memphis) and Division of Neurosurgery, St. Jude Children's Research Hospital, Memphis, Tennessee

3. Department of Radiology, Weill Medical College, Cornell University, New York, New York

4. Children's Hospital Los Angeles, and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California

5. Department of Pathology, Johns Hopkins University, Baltimore, Maryland

6. Department of Pathology, Ohio State University College of Medicine, Columbus, Ohio

7. Children's Oncology Group, Arcadia, California

8. Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee

Abstract

Abstract BACKGROUND: Central nervous system neoplasms are the most common solid tumors in children, and more than 40% are low-grade gliomas. Variable locations, extent of resection, postoperative neurodiagnostic evaluation, and histology have confounded therapy and outcome. OBJECTIVES: To investigate disease control and survival after surgery. METHODS: A prospective natural history trial from 1991 to 1996 produced a subset of patients with low-grade gliomas managed by primary surgery and subsequent observation. Patients were evaluable if eligibility, tumor location, and extent of resection were confirmed by pathological diagnosis, preoperative and postoperative imaging, and the surgeon's report. Primary end points were overall survival (OS), progression-free survival (PFS), and postprogression survival. RESULTS: Of 726 patients enrolled, 518 were fully evaluable for analysis. The 5- and 8-year OS rates were 97% ± 0.8% and 96% ± 0.9%, respectively, and PFS rates were 80% ± 1.8% and 78% ± 2.0%. In univariate analyses, histological type, extent of residual tumor, and disease site were significantly associated with PFS and OS. In multivariate analysis, gross total resection (GTR) without residual disease was the predominant predictor of PFS. In patients with limited residual disease, 56% were free of progression at 5 years. CONCLUSION: GTR should be the goal when it can be achieved with an acceptable functional outcome. The variable rate of progression after incomplete resection highlights the need for new predictors of tumor behavior.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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